Provider Demographics
NPI:1386235877
Name:ANNA KJOSE, PHD, PLLC
Entity type:Organization
Organization Name:ANNA KJOSE, PHD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KJOSE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-801-2840
Mailing Address - Street 1:2301 NW 187TH TER
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-7688
Mailing Address - Country:US
Mailing Address - Phone:636-795-5480
Mailing Address - Fax:
Practice Address - Street 1:3351 W ROCK CREEK RD STE 120
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-2463
Practice Address - Country:US
Practice Address - Phone:405-801-2840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health